Restorative proctocolectomy for collagenous colitis

Riaz, AA; Pitt, J; Stirling, R W; Madaan, Sanjeev; Dawson, Peter

doi:10.1177/014107680009300513

Cited by 13 publications

(5 citation statements)

References 4 publications

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“…Historical evidence ranging back into the prebudesonide time suggests surgical interventions as an ultima ratio for patients with severe symptoms not responding to the at that time available medication [124]. Subtotal colectomy, sigmoidostomy, or diversion ileostomy was reported in individual cases and it remains doubtful that with budesonide being available, such surgeries still being necessary [33, 121, 125, 126].…”

Section: Treatmentmentioning

confidence: 99%

Microscopic Colitis: Epidemiology, Pathophysiology, Diagnosis and Current Management—An Update 2013

Storr

2013

ISRN Gastroenterology

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Microscopic colitis is a common cause of chronic diarrhea. Over the last years the incidence and the prevalence of microscopic colitis are rising and this rise is largely attributed to a rising awareness, and concomitantly an increasing number of diagnoses are made. Patients with microscopic colitis report watery, nonbloody diarrhea of chronic, intermittent, or chronic recurrent course. Following an unremarkable physical examination the diagnosis of microscopic colitis is made by colonoscopy, which shows essentially a normal colonic mucosa. Biopsies taken during the colonoscopy procedure will then finally establish the correct diagnosis. Histological workup can then confirm a diagnosis of microscopic colitis and can distinguish the two distinct histological forms, namely, collagenous colitis and lymphocytic colitis. Presently both forms are diagnosed and treated in the same way; thus the description of the two forms is not of clinical value, though this may change in future. Depending on the patients age and gender 10–30% of patients investigated for chronic diarrhea will be diagnosed with microscopic colitis if biopsies are taken. Microscopic colitis is most common in older patients, especially in female patients and is frequently associated with autoimmune disorders and the consumption of several drugs. This review summarizes the present knowledge of the epidemiology, the pathophysiology, and the diagnosis of microscopic colitis and discusses the former and the present treatment options.

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Section: Treatmentmentioning

confidence: 99%

Microscopic Colitis: Epidemiology, Pathophysiology, Diagnosis and Current Management—An Update 2013

Storr

2013

ISRN Gastroenterology

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“…Although the majority of patients with collagenous colitis respond to medical therapy, some may develop a clinically refractory course, which then requires surgical intervention. IPAA has been reported to be a method of surgical intervention in patients with collagenous colitis (100,101) . Deposition of collagen in the pouch can occur similar to the normal colonic mucosa which can result sometimes in chronic pouchitis as in our patient (20) .…”

Section: Reviewmentioning

confidence: 99%

Secondary Pouchitis: Those With Identifiable Etiopathogenetic or Triggering Factors

Navaneethan

Shen

2010

American Journal of Gastroenterology

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Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for the majority of patients with medically refractory ulcerative colitis (UC) or UC with dysplasia, or familial adenomatous polyposis. Various forms of pouchitis frequently occur after surgery. In fact, pouchitis is the most frequent long-term complication of IPAA in patients with UC, with a cumulative prevalence of up to 50%. The etiology and pathogenesis of pouchitis are not entirely clear. It is generally believed that the initiation and development of the disease process of pouchitis is associated with dysbiosis of pouch reservoir, as evidenced by a favorable response to antibiotic therapy. However, the majority of the patients do not show identifiable etiopathogenetic or triggering factors, therefore being labeled to have idiopathic pouchitis. In contrast, a subgroup of patients, particularly those with antibiotic-refractory pouchitis, may have obvious triggering factors for disease flare-up and progression and may be considered to have secondary pouchitis. Therefore, pouchitis can be classified on the basis of etiology into idiopathic and secondary causes. Approximately 20-30% of patients who present with chronic pouchitis have secondary identifiable and triggering factors, including cytomegalovirus or Clostridium difficile infection, ischemia, concurrent immune-mediated disorders, radiation, collagen deposition, and use of nonsteroidal anti-inflammatory drugs. Careful evaluation of these secondary causes of pouchitis that may contribute to resistance to antibiotics should be performed before the introduction of next-line medical therapy.

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“…If medical therapy fails and alternative diagnoses are ruled out, surgical therapy may be considered for patients with severe MC. Split ileostomy was conducted successfully in nine women with CC, whereas others have reported a successful outcome both in CC and LC after total or subtotal colectomy 48, 85–88 . The proportion of patients that needs surgical therapy today is small considering the progress of medical therapy.…”

Section: Treatmentmentioning

confidence: 99%